A hopeless case?

In 1868 the Richmond Medical Journal reported an extraordinary accident which had befallen a 9-year-old boy at a cotton press in Missouri. Since few of my readers are likely to have an instant mental image of one of these pieces of machinery, here’s a quick description.

A cotton press was a substantial contraption typically made from oak beams. Its function was to compress cotton into bales, using the weight of a massive screw which could be elevated by turning a pair of levers. A team of horses or mules was hitched to the levers and walked in a circle to raise the screw.

The Tarboro cotton press (mid-18th century) in North Carolina

The example described in this article was much bigger than that in my illustration, standing more than forty feet high:

This screw, with its lever of red elm, four by eighteen inches square and ten or twelve feet long, stands in a hole in the ground ten feet deep and twenty-five feet diameter. When the press is up, the lever must be securely propped to prevent the instant violent descent of the whole immense structure with such force as almost completely to compress a heavy bale of cotton. If there be no cotton in the box, the descent continues to the bottom, with momently increasing velocity, hurling the lever around the walk with irresistible momentum.

This was a powerful and extremely dangerous piece of machinery. And not a good place for children to play; but in 1865 that is exactly what happened.

In February 1865, Haygood, a very sprightly boy 9 years old, having never before seen a press of this kind, induced an older boy to go with him into the hole to assist him in running the press up, so that he could see how it was worked.

This sounds like the opening scene of one of those TV medical dramas in which childish misadventure leads, predictably, to a ghastly accident. And with good reason.

Having, by tugging at the lever, run it up four rounds, the older boy held on till Haygood tied up the iron prop to prevent it from stopping the descent when the lever should be released. All being ready, the older boy, being at the place of exit from the walk, stepped out quickly. But Haygood not escaping, the lever, at the first revolution, struck his leg, breaking both bones about the middle. Attempting to rise, on the second revolution the lever struck and crushed his shoulder. On the third revolution, it passed over him; and on the fourth, with its maximum momentum, struck his head, carrying entirely away a large portion of integument, including one eye-brow and part of the hairy scalp with the intervening part. Portions of skull, membranes and brain were also carried away. A piece of skull was found sticking in the lever, and portions of brain on all the twenty-four posts around the circumference of the hole.

Got that? They found pieces of his brain on no fewer than twenty-four posts. If you’re thinking the boy is probably dead by now, think again:

Cloths dipped in cold water were applied to the head every twenty minutes, and every time they were removed, from 11, A. M., till 4 P. M., some brain and considerable blood escaped.

The whole quantity of brain lost, however, could not have been very great; perhaps not more than three tablespoonfuls.

So that’s all right then.

The physician called declined surgical interference, deeming it “worse than useless, as the boy must die in a few hours.”

Well, you can see his point.

The father, a very energetic, intelligent farmer, straightened the broken leg, arranged the shoulder, and dressed the head with cold water. Calomel was exhibited, and next day salts. The latter was repeated several days without effect. Then salt-water enemata were repeated for four days. For eight days nothing given escaped or produced any perceptible effect.

In an era when it was virtually impossible to treat catastrophic cerebral trauma, it is understandable that the only therapy attempted was laxatives and enemas.

The physician, being again called, declined as before, thinking no good could be done by surgical treatment, but ordered food. The father now adjusted the broken bones, and dressed the leg and shoulder as well as he could, succeeding very well, as he had seen such things done many times before. He fed his son well, and in a few weeks the shoulder and leg were well, the latter a little shortened. About this time, a loosened fragment of skull was removed, in shape and size resembling a dessert spoon with a small piece of handle attached. The boy was soon up, and in a little over six months from the date of the accident, the wound in the forehead was completely closed.

Pretty amazing. But poor Haygood was left with one permanent reminder of his misadventure:

A circular opening through the skull as large as a Mexican silver dollar remains, through which every pulsation is visible. This opening is directly over the eye, an inch from the median line and from the superciliary ridge [eyebrows].

It is now nearly three years since Haygood received the injuries, and he continues perfectly well in every respect, with no damage to physical or mental powers. He is very lively, active and intelligent, engaging, with as much zest as any other very stout boy, in all athletic exercises.

A happy outcome which I suspect even few modern doctors would have predicted. Still more surprising: despite losing a large portion of his skull, and a considerable amount of brain matter, Haygood did not lose consciousness at any stage.

The other boy having run for assistance when the accident occurred, Haygood had got out of the hole and ten feet from it when the first man came to him. Disliking this man, young Haygood rejected his proffered aid to carry him to his mother in such decided and forcible language, that he withdrew to the other end of the house and upstairs, where the gristmill was in operation, and sent another man, whose assistance the boy thankfully accepted. Had no assistance been near, he would no doubt have dragged himself home. From the very beginning, he gave a clear account of the whole series of events, with all the minutiae and among other things, he said that in making the last attempt to escape, he felt quite certain that he could do so before another revolution of the lever; but that he had been so much disabled that he failed, till after the last blow, when the press being down, he crawled out without further risk of injury. He recollected how many rounds the press was run up, and exactly how each successive revolution and injury happened.

The author of the article, Dr D. L. Phares, concludes with an observation as valid today as it was 150 years ago.

This case illustrates the wonderful recuperative power of a good constitution, and shows the importance of rendering all the aid at the surgeon’s command, however serious the injuries, or apparently hopeless the case.